Sexual function in women with urinary incontinence and pelvic organ prolapse

Matthew D. Barber, Anthony G. Visco, Jean F. Wyman, J. Andrew Fantl, Richard C. Bump

Research output: Contribution to journalArticlepeer-review

309 Scopus citations

Abstract

OBJECTIVE: To compare sexual function in women with urinary incontinence and pelvic organ prolapse and to determine the effects of therapy on sexual function. METHODS: 343 community-dwelling women older than 45 years with urinary incontinence or advanced prolapse were recruited into a multi-armed clinical trial. Women with incontinence were stratified to receive estrogen therapy, behavioral therapy, or surgical therapy. Women with prolapse were enrolled in a randomized surgical trial. All women completed a standardized urogynecologic evaluation and a sexual function questionnaire at baseline and after therapy. RESULTS: Women with prolapse or detrusor instability were more likely to cite pelvic floor symptoms as a reason for sexual inactivity than were women with other conditions. One third of patients with prolapse reported that their pelvic floor condition affected their ability to have sexual relations "moderately" or "greatly" significantly more than did other groups. Patients with genuine stress incontinence who underwent surgical or behavioral therapy were less likely to report being worried about urine leakage during intercourse after therapy than at baseline. After surgery, women with prolapse were less likely to report that their symptoms affected their ability to have sexual relations compared with baseline. Overall sexual satisfaction was the same at baseline and remained unchanged in all therapeutic groups at 6 months. CONCLUSION: Prolapse is more likely than urinary incontinence to result in sexual inactivity and to be perceived as affecting sexual relations. However, overall sexual satisfaction appears to be independent of diagnosis of or therapy for urinary incontinence or prolapse.

Original languageEnglish (US)
Pages (from-to)281-289
Number of pages9
JournalObstetrics and gynecology
Volume99
Issue number2
DOIs
StatePublished - 2002

Bibliographical note

Funding Information:
We performed a secondary analysis of three clinical trials conducted by the Continence Program for Women and funded by the National Institute on Aging. The study population of the Continence Program for Women consisted of 348 women recruited from three academic medical centers (Medical College of Virginia [n = 222], Bowman Gray Medical Center [n = 113], and Duke University Medical Center [n = 13]) as part of a prospective multi-armed clinical trial between January 1989 and June 1994. All women were 45 years or older, community dwelling, ambulatory, and mentally competent (Mini-Mental Status Examination score > 23). Three hundred sixteen patients had urinary incontinence, defined as involuntary urine loss at least once per week and no pelvic organ prolapse beyond the hymen with straining, and 32 patients had stage III or IV pelvic organ prolapse. Women with urinary incontinence were recruited through newspaper advertisements and articles and from the referral practices of the senior study investigators. Women with prolapse were recruited only from the referral practices of the senior study investigators. Exclusion criteria were reversible causes of urinary incontinence, uncontrolled metabolic conditions, functional disability limiting use of the toilet, indwelling catheterization, genitourinary fistula, and chronic urinary tract infections. Before enrollment, all participants gave informed consent as approved by the institutional human subjects research committee; institutional review board approval was obtained at each of the centers involved in the study. Five women (2 with urinary incontinence and 3 with pelvic organ prolapse) did not complete the sexual function questionnaire at baseline and were excluded from this analysis, leaving 343 women (314 with urinary incontinence and 29 with prolapse) in our study.

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